Single NSAID hypersensitivity is associated with atopic status

The relationship between hypersensitivity to NSAID and atopic status is still incompletely defined. Previous studies found a high prevalence of atopic diseases in multiple NSAID reactors. The present study aimed to investigate whether this is the case also in Italian adults hypersensitive to NSAIDs.

Skin tests with a large panel of seasonal and perennial airborne allergens were carried out in 252 patients with a clear-cut history of acute urticaria induced by nonsteroidal anti-inflammatory drugs. Patients were classified as single or multiple NSAID reactors based on clinical history, presence/absence of chronic urticaria, re-challenge with the reported offending drug in case of doubt history, and oral challenges with aspirin or propionic acid derivatives.

Single NSAID reactors showed a much higher prevalence of atopic diseases than multiple NSAID reactors either with or without chronic urticaria (61% vs 19% and 19%, respectively; p < 0.001).

As a difference from previous reports, in Italian patients hypersensitive to NSAID atopy is much more prevalent among single reactors, a finding that indirectly supports the possible IgE-mediated origin of this type of adverse drug reaction.